by Chris Norton, Managing Director, UK & Ireland, InterSystems
The 42 Integrated Care Systems (ICSs) created under the Health and Care Act (2022), are founded on the principle of partnership. Embedded in the heart of every ICS is an integrated care partnership (ICP), a statutory committee jointly formed between the NHS integrated care board and all upper-tier local authorities that fall within the ICS area. So, by their very nature, ICSs are a combination of healthcare organisations that come together with the intention of planning and delivering joined-up health and care solutions to improve outcomes for people who live and work in their area.
Given the current challenges that the NHS is wrestling with, achieving this vision will not be easy, however. Integrated Care Systems (ICSs) are tasked with delivering the goal of joined-up care against a backdrop of what feels like ever-greater pressure on resources. These new organisations, with varying levels of maturity, face a wide, and evolving, set of challenges that will require the ability to continually adapt and innovate.
The entire health and social care system is continuing to struggle with treatment backlogs amid budget constraints. Social care vacancies stood at 165,000 in October last year and a House of Commons Health and Social Care Committee report said an extra 475,000 jobs would be needed in the health sector, and another 490,000 in social care by the early 2030s.
ICSs must overcome these intense, short-term challenges while innovating to create fresh pathways and workflows that can drive new and transformational methods of delivering care. Most fully understand these issues but are nevertheless often forced to transform themselves in flight, as the environment in which they operate continuously changes.
For patients, ICSs should be delivering the manifold benefits of cross-collaboration between what have previously been very independent NHS trusts and social care providers. However, volatile economic factors, a lack of resources and ongoing skills shortages resulting from the pandemic, and demographic change, have made the job of joining up healthcare to improve outcomes an extremely difficult one.
ICSs have the potential to deliver multiple benefits to the healthcare system in the UK, allowing cross-collaboration between independent trusts to provide an enhanced and more joined-up patient experience. However, these disparate organisations often find themselves building the future of healthcare on the fly, while still having to deal with multiple immediate challenges.
From patient backlogs to multi-million budget deficits, there are many factors trusts must take into consideration. Transformation is necessary as these trusts determine how best to share information across regions, jurisdictions, and care boundaries, as well as integrating health and social care into them as well.
Building long-term relationships
It is worth highlighting at this juncture though that ICS transformation is about much more than just simply upgrading IT infrastructures, it’s a long term organisational and community relationships change programme. The right technology provides the potential to improve patient outcomes, optimise clinician workflows, and secure cost savings.
However, implementing digital solutions in healthcare is an adaptive change, not just a technical one. It’s not about simply buying software, it’s a cultural and human shift, or transformation. In the case of large transformation projects, the impact of the shift on those at the very heart of healthcare – the practitioners – is particularly pronounced.
So, the NHS needs partners that are simultaneously able to help make quick progress and achieve rapid time to value, and who are also committed to being with them over the long-haul. It is both a marathon, and a series of sprints – and partners should be willing to agree integrated, outcome-based commercial agreements.
After all, it is no longer acceptable for any vendor to turn up, do their bit, drop off their solution, and wish the customer good luck – the challenges are too big and too complex for this kind of culture and these kinds of relationships to survive.
Key role of change management
Consequently, vendors delivering to the healthcare sector can never afford to concentrate exclusively on the systems and solutions they are delivering, even if that is their bread and butter. They need to be focused just as much on change management.
Given this, the cultural and human impact of healthcare transformation must be considered at every turn. That’s why putting a strong change management strategy in place is key. But delivering on it is often easier said than done, especially in the complex healthcare space.
According to the Change Management Institute UK:
“Change management represents a domain of principles and practices that enable stakeholders of change to adopt the mindsets, behaviours, and capabilities required for that change to deliver full business value. It focuses on people.’’
In the context of healthcare, that means stakeholders, including technology providers, working in partnership to achieve common goals.
Working in collaboration
This emphasis on collaborating to achieve common goals is very close to our hearts at InterSystems. We wholeheartedly believe that rather than just focusing on technology delivery, providers should be concentrating instead on delivering accelerated time to value, and more effective, less stressful collaboration throughout every ICS customer’s region.
By taking a coherent and integrated whole system approach to healthcare and social care data, providers should be focused on setting ICSs up for success, first time around. Equally, by ensuring all partnership organisations within the ICS can have accurate administrative and clinical information whenever and wherever they need it, technology companies can streamline collaboration, helping everyone work together more effectively. This in turn frees up ICS capacity and capability, so partner organisations can focus on the more sophisticated, longer-term challenges, and goals for their region.
Technology is key too but must fit with the vision
To fit with this vision of flexible, collaborative working practices, it is important that the solutions that ICSs adopt have a similar level of in-built adaptability, allowing them to readily form a platform that can help create a new ecosystem of seamless, multi-discipline treatment, and care plans. Any solution or system must be capable of maximising outcomes within fluid resource parameters, quickly and without disruption. Otherwise, its useful lifespan will be too short.
In line with this, ICSs will benefit from taking a platform-led approach that sits above, and integrates all their current systems or workflows. This means the data can stay where it is, while providing a single source of truth that massively streamlines the time and energy it takes healthcare staff to find and share the right information. And it also means staff don’t need to be retrained with working patterns changed overnight – it offers almost immediate benefits, while still helping ICSs make more gradual and consistent progress, without interrupting service delivery and patient care.
This kind of non-disruptive change saves time because the process is smoother, and it also saves budget because a flexible interoperability platform can help ICSs integrate and make best use of the tech infrastructure and skills it has already, rather than having to start all over again.
This is especially true in an area such as shared patient records, where we can already see that implementations which lack adaptability are experiencing significant fall-offs in performance – posing a dilemma for senior managers about whether to supplement or replace them. At one time this might not have been viewed as a critical decision, but the successful response to Covid has made this more significant. It has taught everyone what is possible with data if it is managed properly. Expectations are higher around the speed of delivery possible with access to high quality data from fast, interoperable and available systems that meet new demands at short notice.
A focus on data integration and system interoperability will be key in ensuring that the technology delivered by providers is able to support a collaborative approach to change across ICSs. To drive operational efficiencies, it is important that administrative and clinical data can be integrated across systems and platforms, so that, for example, the same waitlist, appointment, and clinical information is shared by administrative and clinical staff.
Coming together to deliver real change
Looking at the current status of healthcare across the UK, it is clear that change is urgently needed to improve patient outcomes, optimise clinician workflows to deal with increased demand, and manage a lack of resource across the sector. But this need brings about a corresponding requirement for collaboration, and a well thought-out and well-implemented strategy to support it.
That entails stakeholders across ICSs and wider healthcare ecosystems working in partnership to achieve common goals. It means focusing on people and how they can form trust-based relationships in order to drive through the changes required. Technology is a key element of this process of course, but focus on working together positively to effect change is equally crucial for ICS transformation to happen, and for UK healthcare to move positively forward into the future.